Dr. Fauci: “Why we really do need an HIV vaccine in spite of the spectacular successes in prevention”

In 1957, public health efforts on the Zanzibar archipelago off the coast of Tanzania confronted the malaria threat there with an all out attack on the parasite that spreads the disease. The result was rewarding, with the disease all but eliminated there. In more recent years, the same effort was repeated, with similar success. Why twice? Because the response to the success of the first time led public health officials to deduce their work was done.

The questionable wisdom of that thinking is built into a tendency of human nature, Dr. Anthony Fauci said Tuesday: “recidivism.”

The week after the the HIV R4P conference in Cape Town South Africa highlighted the potentials of an array of biomedical measures to control the virus that leads to AIDS, Fauci remembered the lesson of Zanzibar to support why only a vaccine will be the “nail in the coffin of the epidemic.”

Fauci, 30 years the head of the National Institute of Allergy and Infectious Diseases, has been counting tolls from the epidemic since the week after a June 5th report from the Centers for Disease Control and Prevention described the cases of five young men, two of whom had already died, all treated for a pneumonia that people with normal immune systems don’t get.

Since then, he listed rapidfire, 78 million people have been infected with the virus those five young men had, 39 million have died of it, 35 million people live with the virus, and last year about 2.1 million people became infected with HIV. The number that makes him pause is one of the smaller ones — the 50,000 new infections in the United States last year. In a country with the resources to educate and treat everyone who needs it, that number has stayed steady for more than two decades. It’s another reason a vaccine is necessary, he said.

Fauci was joined by Mitchell Warren of the HIV research advocacy group AVAC and Margie McGlynn of the International AIDS Vaccine Initiative — IAVI — at the Center for Strategic and International Studies. The array of biomedical interventions, realized and in progress, that were discussed at last week’s HIV R4P meeting will complicate the quest for a vaccine, because they add to the options that clinical trial participants must also be able to access, said Warren who had just returned from the conference. Those options mean trial participant populations will have to be larger, trials longer, and data more intricate. Those options also support the need for HIV vaccine development, he noted, because alone they don’t stop all infections. With more trials, and more expensive trials to come, and no end in sight, Warren added, policy makers as well as researchers need to be prepared for continued commitment, as well as delays.

History supports that commitment, added McGlynn, who also attended the Cape Town conference, “What if we had given up on a polio vaccine?”

The demands of the ongoing Ebola crisis in West Africa kept Fauci from the conference. Close to 5,000 people, likely more have died of the disease, and least 13,000 people have been stricken with the virus since the outbreak began in March, he noted.

“Yesterday, forty-one hundred people died of AIDS. Yesterday, fifty-seven hundred people got infected with HIV,” he added. “Every single day, forty-one hundred people die of AIDS. Every single day.”